Dr. Gangemi’s New Patient Forms

By clicking on the below links you can read my Office Policies and Procedures (includes appointment fees), as well as the New Patient Forms and HIPAA NPP form. New patients are scheduled for a 2-hour time block initially with 2 follow-up appointments, one hour each. Out-of-area patients should plan on spending 2 consecutive days in town so I may follow-up with you the day after (or 2 days after) your initial appointment. Please call the office for information about local accommodations.

Please download the following New Patient Forms to fill out once we have called you and arranged an appointment time.

At least two weeks prior to your appointment – return signed Form 1A or 1B

To bring in with you during your appointment –

Form 2A (Male or Female) or 2B for Children under age 4

Form 3.0 HIPAA NPP

Form 4.0 (recommended, but not required)

Please make sure you print the correct forms. If you are not sure please call or email us.

2A: Adult and Children Over Age 4 New Patient History Forms: (MALE FORMS / FEMALE FORMS) Please print, fill out completely, and bring in with you during your appointment along with lab work, supplements, medications, and any orthotics & common footwear.

Disclaimer

DrGangemi.com is intended to help individuals become better informed consumers of health care. The information presented on this site gives general advice on health care and fitness aspects and is not intended to treat, diagnose, prescribe, or replace any health care visit. The entire contents of this website are based upon the opinions of Stephen C. Gangemi, DC, unless otherwise noted. DrGangemi.com is intended to share knowledge and information from the research and experience of Dr. Gangemi and his community. Dr. Gangemi encourages you to make your own health care decisions based upon your research along with your qualified health care professional.